Before you apply
- This application must be submitted by the Licence holder to request the termination of a licence, or a person authorised to submit on their behalf.
- Prepare the supporting documents you may have to support your online application form.
- A Terminate a Licence - Licence holder/s consent form (PDF, 216 KB) signed by all Licence holders
- Evidence of authority to act where applicable
- A copy of a registered power of attorney where applicable
- A copy of your Certificate of Incorporation (from NSW Fair Trading) and minutes showing elected office bearers where applicable
- A recent company search (Australian Securities & Investments Commission) which lists company officeholders (directors and secretaries) and Authorised signatories where applicable
- Photos to evidence that the land has been left in a clean and tidy condition
- If there are structures on the land include photos to evidence that the structures have been removed or provide evidence that the department has consented to the structures remaining on the land
- If the licence holder is deceased and the application is being lodged by an Executor/Administrator:
- A copy of the Death Certificate
- A copy of the Will
- A copy of the Probate or letters of administration
You will be invoiced for the fee once your application is checked and accepted.
Important information about this form
- Applications with missing information will not be accepted.
- Lodgement of this form does not guarantee that your licence will be terminated.
- The department may require you to undertake certain activities, such as remediation of land, removal of structures or payment of outstanding amounts prior to termination being considered.
- The termination of a licence does not waive any outstanding rent on the licence.
- Any amounts outstanding upon termination will continue to be a debt that is pursued by the department.
- By selecting the Submit button, you have read and agreed to the department's Privacy statement.
- The fields marked with an asterisk * are mandatory and must be completed in order to submit the form.
- After you have submitted your form, a copy of the application will be emailed to the address entered in the form or a copy can be saved or printed